Lesions produced by the extravasation of urine from the upper urinary tract

We present six cases which illustrate the spectrum of clinical features, macroscopic findings and light microscopic findings of urine extravasation from the upper urinary tract. The early lesions are characterized macroscopically by an oedematous, glistening or gelatinous appearance to the renal per...

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Bibliographic Details
Published in:Histopathology 1997-04, Vol.30 (4), p.335-340
Main Authors: CARR, R.A., NEWMAN, J., ANTONAKOPULOS, G.N., PARKINSON, M.C.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Amylases - metabolism
Biological and medical sciences
Coloring Agents
Female
Humans
Male
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Pelvis - pathology
Tamm-Horsfall protein
upper urinary tract
Urinary system involvement in other diseases. Miscellaneous
Urinary Tract - injuries
Urinary tract. Prostate gland
urine extravasation
urinoma
Urologic Diseases - etiology
Urologic Diseases - pathology
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Summary:We present six cases which illustrate the spectrum of clinical features, macroscopic findings and light microscopic findings of urine extravasation from the upper urinary tract. The early lesions are characterized macroscopically by an oedematous, glistening or gelatinous appearance to the renal perihilar and peripelvic fat. Light microscopically there is lipolysis with associated foamy macrophages, multinucleate giant cells and lymphocytes. Immunohistochemical staining for Tamm–Horsfall protein is strongly positive in the extracellular space and in the foamy macrophages confirming urine extravazation. Later lesions are characterized by cicatrization of fibrous tissue around the renal pelvis and hydronephrosis. Microscopically there is relatively bland fibrosis with occasional lymphocytes and histiocytic cells. The late lesions are also characterized by extracellular deposits of weakly eosinophilic, granular or hyaline material, the so called ‘urinary precipitates’. These deposits stain strongly with diastase PAS and weakly positive for Tamm–Horsfall protein. The staining of these urinary precipitates is analogous to renal tubular hyaline casts, thus supporting the theory that they are derived from uroproteins. We consider that these deposits are pathognomic of past urine extravasation.
ISSN:0309-0167
1365-2559
DOI:10.1046/j.1365-2559.1997.d01-623.x